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Sero-Surveillance (Igg) of SARS-Cov-2 Among Asymptomatic General Population of Paschim Medinipur, West Bengal, India

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Sero-Surveillance (Igg) of SARS-Cov-2 Among Asymptomatic General Population of Paschim Medinipur, West Bengal, India medRxiv preprint doi: https://doi.org/10.1101/2020.09.12.20193219; this version posted September 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Sero-surveillance (IgG) of SARS-CoV-2 among Asymptomatic General population of Paschim Medinipur, West Bengal, India (Conducted during last week of July and 1st week of August 2020) - A Joint Venture of VRDL Lab (ICMR), Midnapore Medical College & Hospital & Department of Health and Family Welfare, Paschim Medinipur Satpati PS1*, Sarangi SS2*, Gantait KS3#, Endow S4#, Mandal NC5#, Kundu Panchanan6#, Bhunia Subhadip7#, Sarangi Soham8# Abstract:- Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic, and the infection due to SARS- CoV-2 has now spread to more than 200 countries 3. Surveillance systems form the foundation stone of active case finding, testing and contact tracing, which are the key components of the public health response to this novel, emerging infectious disease 4. There is uncertainty about the true proportion of patients who remain asymptomatic or pre-symptomatic at a given time. As per the WHO-China Joint Monitoring Mission Report, and an analysis of 21 published reports, anywhere between 5 and 80 per cent of SARS-CoV-2-infected patients have been noted to be asymptomatic 5, 6 Whereas in India 4197563 cases are positive, in which in West Bengal total 180788 cases (4.04% of Cases of India) positive of COVID 19. In Paschim Medinipur (West Medinipur) district contributing total 5489 cases (3.03% cases of West Bengal) 9 , 10,11. In this scenario, we want to know the status of IgG seroprevalence of SARS-CoV-2 among asymptomatic general population, so that we can determine the extent of infection of SARS-CoV-2 in general population. Objectives:- Primary Objective:- To estimate the seroprevalence for SARS-CoV-2 infection in the general asymptomatic population at Paschim Medinipur District. Secondary Objectives- To estimate age and sex specific seroprevalence. To determine the socio demographic risk factors for SARS-CoV-2 infection; To determine the other risk factors like comorbidities, vaccination status, travel history, contact history etc.; To determine the durability of Immunity (IgG) conferred by natural infection of SARS-CoV-2 in individuals previously RTPCR positive. Methodology: It was a cross sectional 30 cluster study among the population of Paschim Medinipur district of West Bengal conducted in last week of July and 1st week of August 2020 among 458 asymptomatic general population and 30 RTPCR positive cases in 30 villages or wards of municipalities. 30 clusters were chosen from list of COVID 19 affected villages/wards of municipality as per PPS (Probability Proportional to Size) method. Results: Of the 458 asymptomatic general population,19 asymptomatic people found to be seropositive IgG for SARS-CoV-2 with Mean or average total seropositivity rate of 4.15%. 19 Out of 30 (63.33%) RTPCR positive patients found Seronegative. Median of Days between RTPCR test and sero negativity found was 60 with minimum 28 days to maximum 101 days and Range of 73 days and a standard deviation of 19.46. Among risk factors, the risk of having IgG is more in persons having Travel history with odds ratio of 2.99- 95%CI (1.17- 7.65) with p-value-0.02. Hydroxychloroquine prophylaxis with Odds ratio of 8.49- 95% CI(1.59-45.19) with p value - 0.003. Occupation as migrant labour with Odds ratio of 5.08- 95% CI(1.96-13.18) with p value of 0.001. H/O Chicken pox with Odds ratio of 2.15- 95% CI(0.59-7.79) with p value of 0.017. Influenza vaccinated with Odds ratio of 8.07 with 95% CI (0.8-81.48) with a p value of 0.036. Conclusion: Of the 458 asymptomatic general population,19 asymptomatic people found to be seropositive IgG for SARS-CoV-2 with Mean or average total seropositivity rate of 4.15%. 19 Out of 30 (63.33%) RTPCR positive patients found Seronegative. Median of Days between RTPCR test and sero negativity found was 60 with minimum 28 days to maximum 101 days and Range of 73 days and a standard deviation of 19.46. Those having Travel History and having occupation as Migrant Labourer – have significantly higher probability of getting infected with SARS-CoV-2. No role has been found of Hydroxychloroquine Medicines as Chemoprophylactic. No durable immunity conferred by natural infection with SARS-CoV-2 –mean time to become seronegative after positive RTPCR test 60 days. So there is a chance of reinfection after average 2 months. 1-MD, Head of the Department, Dept. of Microbiology, Midnapore Medical College and Hospital, Medinipur, Paschim Medinipur, WB, INDIA; 2- DPH, MPH, Deputy Chief Medical Officer of Health- I, Paschim Medinipur District, WB, INDIA;3- MD, Professor, Department of Medicine, Midnapore Medical College and Hospital, Medinipur, Paschim Medinipur, WB, INDIA;4-MD, Assistant Professor, Department of Microbiology, Midnapore Medical College and Hospital, Medinipur, Paschim Medinipur, WB, INDIA;5-Chief Medical Officer of Health, Paschim Medinipur District, WB, INDIA;6-MS, Principal, Midnapore Medical College and Hospital, Medinipur, Paschim Medinipur, WB, INDIA; 7-DPH, SMO, NPSP Unit Kharagpur, WHO-India ; 8-2nd Professional MBBS, Medical College, Kolkata, WB, INDIA *- Principal Investigator; contributed equally #- Co-Investigator NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.09.12.20193219; this version posted September 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . INTRODUCTION: Serosurveys are studies that test body fluids, most commonly blood but also oral fluid, to estimate what proportion of the population has been vaccinated against or previously infected with a pathogen—and how many people remain susceptible 1. Conducting population-based serosurveillance for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) will estimate and monitor the trend of infection in the adult general population, determine the socio-demographic risk factors and delineate the geographical spread of the infection 2. Coronavirus disease 2019 (COVID-19) has emerged as a pandemic, and the infection due to SARS- CoV-2 has now spread to more than 200 countries 3. As on 6th September 2020, the Confirmed cases in India stood at 4197563, West Bengal had 180788 confirmed cases, and Paschim Medinipur District had 5489 confirmed cases.9,10,11 Surveillance systems form the foundation stone of active case finding, testing and contact tracing, which are the key components of the public health response to this novel, emerging infectious disease 4. There is uncertainty about the true proportion of patients who remain asymptomatic or pre-symptomatic at a given time. As per the WHO-China Joint Monitoring Mission Report, and an analysis of 21 published reports, anywhere between 5 and 80 per cent of SARS-CoV-2- infected patients have been noted to be asymptomatic 5, 6 The WHO global research map for COVID-19 and others recommend population-level sero epidemiological studies to generate data on the levels of infection in populations and recommend containment measures accordingly7. In order to achieve this, a protocol for conducting such population- based sero-epidemiological investigation for COVID-19 has been proposed by the WHO 8. Serosurveys involve collection of specimens to measure the presence and level of antigen-specific antibodies in a group of people. It reveals what proportion of the population has been exposed to an infectious disease or has been vaccinated against a pathogen. It also estimates the level of population immunity to one or more infectious diseases; Sero Survey identifies gaps in immunity because people were not vaccinated or previously infected. Immunity gaps can be in specific age groups, certain locations, or among specific populations such as migrants. Identifying immunity gaps can guide immunization programs. It estimates parameters for modelling and transmission dynamics to measure disease burden and guide immunization programs 12. Serologic studies are crucial for clarifying dynamics of the coronavirus disease pandemic. Past work on serological studies (e.g., during influenza pandemics) has made relevant contributions. Although detection of antibodies to measure exposure, immunity, or both seems straightforward conceptually, numerous challenges exist in terms of sample collection, what the presence of antibodies means, and appropriate analysis and interpretation to account for test accuracy and sampling biases. Successful deployment of serologic studies depends on type and performance of serologic tests, population studies, use of adequate study designs, and appropriate analysis and interpretation of data. We highlight key questions that serologic studies can help answer at different times, review strengths and limitations of different assay types and study designs, and discuss methods for rapid sharing and analysis of serologic data to determine the extent of transmission of SARS-CoV-2. SARS-CoV-2 serologic studies has largely focused on 2 questions: first, what proportion of a population has been infected; and second, what proportion of a population is immune to disease or infection? Firstly, for infections that elicit detectable antibody responses, serologic studies can detect past infection regardless of clinical symptoms. This capability is useful for understanding the extent of past transmission13. Secondly, if measured antibody responses correlate with protection, serologic studies can be used to measure the proportion of the population those who are immune.
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